RPMS - EHR v1.1 Techie Class

1. RPMS - EHR v1.1 Techie Class September 2007 Really Powerful at Measuring Stuff

2. Student Questions • Questions posed during the class • Answers from the presenters and students

3. Can’t Log into RPMS While in EHR Question • I have EHR users that have correct class keys, BGO keys, but cannot log into RPMS while they are in EHR.  • Would this be resolved with the VueCentric updates service file?  I have been told this is a permissions issue.  How would this be resolved?

4. Can’t Log into RPMS While in EHR Answer • Most likely the user doesn’t have multiple sign-on allowed. • Inspect/correct the user account • User option: Edit an Existing User • On page 2, field Multiple Sign-on should be “Allowed” and Multiple Sign-on limit should be at least 2 or 3.

5. Can’t Log into RPMS While in EHR

6. CCOW Version Supported? Answer • Specification version 1.1 is currently supported.

7. Electronic Signature? Question • Is there an electronic signature for the EHR Demo? Answer • Vuecentric

8. Launching Demo RPMS Question • How do we get into RPMS?

9. Launching Demo RPMS Answer • Via Windows Start > Programs > Cache > Cacheweb > Terminal  • Access Code: user123 • Verify Code: user321$ • Or, via clicking on the Communication tab in EHR and then clicking the RPMS link from the left menu • Username: RPMS • Password: <enter> no password required • Access Code: user123 • Verify Code: user321$

10. Adding Components Question • Can the education and health factors objects be added to another tab such as the Prob/POV tab if the Categories tab of the Object Registration is blank in vcManager?

11. Adding Components Answer • First, when the Categories tab initially appears, only previously checked items are visible. To see all possible entries, right-click on the tab and select Show All Categories from the popup menu. Categories determine the placement of an object in the tree view control within the Add Object dialog of the Visual Interface Manager.

12. Adding Components Answer • Second, the Special Settings tab of Object Registration will show you whether a given object can be placed in multiple tabs. If the Allow Multiple Instances checkbox is selected (checkmark shown) then that object may be placed in multiple locations. Both the education and health factors objects permit multiple instances.

13. Pick List....still side to side… Question • Can scroll bar be placed on side to scroll up and down? Answer • The splitter bar has a vertical orientation, meaning it visually is top to bottom. The scroll bar can only move left or right.

14. Templates stored? Question • Where are the templates stored- local computer or server? • Can they be backed up as part of the backup program the windows admin runs?

15. Templates stored? Answer • The templates are stored in the database you’re logged into.  So, if you’re on a local RPMS database (located on your PC), then the templates are stored on your PC.  In most production instances, the users will be logged onto a server database, so the templates would be stored on the server.   • Yes, the databases can be backed up, just include the Cache folders in the backup plan.

16. VueCentric.ini Question • Are all the files in the bin folder (master copy) supposed to be listed in the VueCentric.ini? Answer • No

17. EHR Failover? Question • If default server (EHR local...ie its down) is not available will it failover to EHR -Remote server on application startup? Answer • No. This is not a standard setup. However, a failsafe/failover solution is technically feasible as part of a business continuity program.

18. Communications Tab… Design Mode… Question • After adding a new node in the communication tab, in the design mode, can you change the name of the node? Answer • Right-click on item and select Properties • Click node editor button • Click on item in list and click pencil tip icon (rename operator) • Type in the desired new name and click OK button

19. Communications Tab… Design Mode…

20. IE Component Question • How do you pass security context to new IE window (web outlook) so that it does not prompt the user for a password/user name? Answer • The IE component operates in a similar fashion as the Internet Explorer application on your PC. Consequently, it will use the Windows IE settings and cookies, cached pages, etc, but is limited in it’s navigational abilities. • As far as using autofill field values, this is website specific. In the case of Web Outlook, you must enter your credentials. Other sites, like the New York Times, will automatically log you in.

21. Cover Sheet Kernel Alert Question • Advantage of Cover Sheet Kernel Alert:  Provider seeing patient can easily see if this patient has any alerts/notifications. • Why isn’t the Kernel Alerts component used at most EHR sites? Answer • The Kernel Alerts was the VA component and is display only. • It has been superceded by the Notifications component.

22. Updating Problem List Question • How are problems entered and updated in CPRS (BEH) Problem List? Answer • The BEH problem list is only used for viewing.  Problems are entered/edited on the Prob/POV tab.

23. Patient Detail Question • Can "Patient Detail" content be adjusted? Answer • Yes, you can use a Health Summary in place of the program presently being used, • or if you are a MUMPS programmer, you may write your own program to replace the one present.

24. Patient Home Directions Question • Out PHNs would like to have the directions to the patients home (which is included in the "Patient Registration" Package.  Can we do this? Answer • Yes, you can use a Health Summary in place of the program presently being used, • or if you are a MUMPS programmer, you may write your own program to replace the one present.

25. Problem List Question • Why aren’t we using the VA version of Problem List so that clinicians can manage their problem lists? Answer • The BGO (IHS) version of the Problem List is being utilized. You could use the VA version by incorporating the BEH component… On the Prob/POV tab.

26. Lab Results Component Question • What is the parameter to set the “# of days back” for the Lab Results component on the cover sheet? Answer • To set, use the new RPMS-EHR CONFIGURATION MENU • Choose LAB and then • CVR    Days of Lab Results to Retrieve (Cover Sheet) • The parameter is BEHOLRCV DATE RANGE

27. VA CPRS and EHR v1.1 Question • What version of the VA's CPRS is included in EHR Versions 1.1? Answer • CPRS 20

28. VA CPRS and EHR v1.1 Question • What CPRS version will be utilized with the next Version of EHR? Answer • That will be determined by IHS

29. National Reminder Templates Question • The VA has begun to develop national "Reminder Dialog" templates.  Do we need CPRS Version 26 to do the same within IHS? Answer • Not necessarily version 26 but higher than 20. Reminders version 2.0 must be present, which cannot be installed until after the Code Set Versioning Update project is completed in early 2008.

30. BEH Notifications Question • Are BEH Notifications sorted?  Can we track notification responses?  Example One:  Provider is sent notification by coding department that an error in the patient record needs to be clarified.  Provider deletes notification and makes change to patient record but coding department does not know that change has been made.  Example Two:  Documentation that provider has viewed the laboratory results notification.

31. BEH Notifications Answer • Are BEH Notifications sorted?  Yes. • Can we track notification responses? Yes. • There are two types of notification files.  • The file that contains notifications is purged every 14 days. • The notification tracking file is purged every 30 days. • However, in the EHR on the Notification Setup Menu is an option Archive (delete) after <x> Days where you can setup an individual notification to be tracked for up to 220 years.

32. BEH Notifications (cont.) Answer • There is also an alert management menu which has reporting options:    SURO   Alerts - Set/Remove Surrogate for User          Delete Old (>14 d) Alerts          Make an alert on the fly          Report Menu for Alerts ...  <== Several reports are here          Set Backup Reviewer for Alerts          Surrogate for which Users?

33. "Where are all the macro’s documented at?"  Question • Where are the different macro's listed with usage? For example, we were shown ($user.name) in class. Answer • We believe you are referencing the replaceable parameters feature. This functionality is described in the ReplaceParams section of the EHR v1.1 Technical Manual.

34. BEH Visits - Appointment Component  Question • No configuration parameters? • What determines the date range for appointments that are displayed on the coversheet? Answer • Two parameters are available: • ORQQAP SEARCH RANGE START • ORQQAP SEARCH RANGE STOP

35. Lab Component  Question • What determines the date range for labs that are displayed? Answer • Two Parameters: • ORQQLR DATE RANGE OUTPT • ORQQLR DATE RANGE INPT

36. Employee Data Viewing Protocol  Question • Could you please send the protocol on employee records or employee health records viewing by other employees.

37. Employee Data Viewing Protocol  Answer: Business Rules: • If you place a Document Class called EMPLOYEE HEALTH under Progress Notes and create the title(s) for Employee Health in that class, then these rules should do what you need. The other appropriate actions should be covered by rules in the Progress Notes class: 1    An UNSIGNED (DOCUMENT CLASS) EMPLOYEE HEALTH may BE VIEWED by an EMPLOYEE HEALTH 2    An UNSIGNED (DOCUMENT CLASS) EMPLOYEE HEALTH may BE VIEWED by a CHIEF, MIS 3    An UNSIGNED (DOCUMENT CLASS) EMPLOYEE HEALTH may BE EDITED by an EMPLOYEE HEALTH 4    An UNSIGNED (DOCUMENT CLASS) EMPLOYEE HEALTH may BE EDITED by a CHIEF, MIS 5    An UNSIGNED (DOCUMENT CLASS) EMPLOYEE HEALTH may BE SIGNED by an EMPLOYEE HEALTH 6    An UNSIGNED (DOCUMENT CLASS) EMPLOYEE HEALTH may BE SIGNED by a CHIEF, MIS 7    A COMPLETED (DOCUMENT CLASS) EMPLOYEE HEALTH may BE VIEWED by an EMPLOYEE HEALTH 8    A COMPLETED (DOCUMENT CLASS) EMPLOYEE HEALTH may BE VIEWED by a CHIEF, MIS 9    A COMPLETED (DOCUMENT CLASS) EMPLOYEE HEALTH may BE PRINTED by an EMPLOYEE HEALTH 10   A COMPLETED (DOCUMENT CLASS) EMPLOYEE HEALTH may BE PRINTED by a CHIEF, MIS

38. Available Reports Not Visible Question • In following along the creation steps for the Reports tab from the Design Mode class, the resulting template did not show any Available Reports. The template that I am using is the same template that Mary had the class modify. I compared this template with the %PROVIDER and updated to match the Design properties including the selections for Required Services and still no Available Reports were visible.

39. Available Reports Not Visible Answer • The condition that you produced is a known defect when exiting Design Mode for the object in question. • Simply exit completely from the EHR, launch EHR and log into the system as usual. • Clicking on the Reports Tab (with a patient selected) will now reveal the available reports, as expected, and any relevant patient data.

40. Last # of Meds… Med Class… Question • We can do last med or last med class, will we ever be able to do last # of meds or med class?  For example, I have a patient who is currently on warfarin 2mg tabs (MoWeFr) *and* warfarin 3mg tabs (TuThSaSu).  If I use the existing objects, I'll only get one of them (whichever was filled last, even if by a nanosecond).  I really need a way to get both of the current warfarin strengths in this object.  This could happen with other drugs, too (i.e. phenytoin).

41. Last # of Meds… Med Class… Answer • You can create a HS for that particular med that brings 3 occurrences or more… • then create a TIU object with this HS.

42. TaskMan Jobs… Question • What TaskMan jobs need to be running in order to keep the EHR well maintained?  What other procedures (if any) are needed to keep the EHR healthy? Answer • The TIU Nightly Task and PSO Expire Prescriptions jobs should be scheduled daily.

43. MS Windows Vista Supported? Question • Will RPMS EHR GUI work on machines with Windows Office Vista? Answer • Using MS Windows Vista has been tested in a very preliminary fashion and plans for a full evaluation have not been formed yet. • Windows Vista is not currently supported by the VueCentric framework.

44. Power User Question • Don't all EHR users need "Power User" rights to run EHR? Answer • Prior to the introduction of the VueCentric Updater service, the Power User rights were necessary. With the deployment of the updater service, with its permissions to maintain the components locally, the individual EHR user does not need the Power User rights setting.

45. Available Providers List Question • Why do I not appear in the list of available providers in the encounter dialog? Answer • The parameter BEHOENCX PROVIDER controls who can be a provider on a visit.  Contact your Application Coordinator to set this parameter for you. • This also can happen if the provider has a status of Disuser, which can happen in those sites who have outside providers set up in the EHR for use by Pharmacy, Lab, and Radiology orders, or if the given provider works intermittently.

46. Improper Terminations Question • Explain "Improperly Terminates" statement in locked patient record message. Answer • Anytime that the connection to the RPMS server is abruptly lost… That is, whenever the user has not properly logged off.

47. IHS Demo Patients Statement • IHS contention for identifying "demo patients" in the Demo database is as follows: • Demo, Patient Father • Demo, Patient John • Demo, Patient Gillian

48. Import Key on Personal List Under Patient Question • Under the patient, on the personal list how do you use the import key?  Is that similar to template importing/exporting? Answer • The import on the personal list is a way to import a selection of patients from a ward or clinic list. It is not am import similar to template importing/exporting.

49. Import Key on Personal List Under Patient

50. Personal List Under Patient Question • Personal list under the patient – how can others see it? Answer • You can’t. This list is a private list and cannot be shared.